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UK: Opinion: As a GP, I don’t get angry with anti-vaxxers, I just give them the facts | The Guardian.

[Wed 5 Feb 2020] Ann Robinson writes:

Here’s one anniversary I won’t be celebrating: 10 years ago this week, the Lancet retracted an article published in 1998 that linked the measles, mumps and rubella (MMR) vaccine to autism. The retraction followed a General Medical Council (GMC) ruling that lead author Andrew Wakefield had been dishonest.

After the original paper, and despite the immediate objections raised by the medical community, there was a significant drop in MMR rates in the UK. In my GP surgery, rational people expressed concerns along the lines of “There’s no smoke without fire”, “I’ll wait until my child is older so that I can be sure they’re not autistic”, “My friend’s child was diagnosed with autism a few months after his MMR” and “I’ll get the jabs done privately so they can be given separately”.

The success of vaccination programmes means that we get complacent and forget that these childhood infections can kill. Parents of babies born today in the UK are unlikely to ever come across measles or meningitis, and there hasn’t been a naturally occurring case of polio in the UK since 1984. A mother told me recently that she was against vaccination and didn’t believe the illnesses were a threat nowadays. She’s right – because most of the other children in her baby’s cohort will be vaccinated, hers is likely to be safe because of herd immunity. I sent her some links and asked her to reconsider. As GPs we’re not supposed to get cross so I didn’t say what I really thought.

On the whole, MMR rates have improved over the past 10 years although they remain just below the WHO recommended coverage of 95% or more. At its lowest ebb, in 2003-04, only 80% of under-twos in the UK were given MMR. Reasons for the improvement in uptake probably include the passage of time, detailed rebuttals of Wakefield’s work, the discovery of his possible conflicts of interest and the absence of further studies to validate his claims. The public appears to have recognised that sometimes there is smoke without fire.

Fear has also played a part in improving uptake. There have been measles outbreaks in Orthodox Jewish communities in the US and Europe. Local rabbis have responded by urging their followers to vaccinate their kids and there is some evidence that this has been effective.

But on a global scale, attitudes and wariness of officialdom can be harder to shift. The WHO is concerned that there were more cases of measles in 2019 than in any year since 2006 and that multiple countries have declared outbreaks. Inevitably, children in the lowest-income countries are most at risk. A measles outbreak late last year killed more than 6,000 people in the Democratic Republic of the Congo alone. But measles isn’t Sars or a new coronavirus, so the deaths attracted relatively little international attention.

We live in paradoxical times. We buy more unproven, expensive “healthcare” products and treatments than ever before. Wellness products, such as those seen in Gwyneth Paltrow’s Goop Lab on Netflix, enjoy enormous success, even as they are criticised by figures like the head of the NHS. Many seem willing, even happy, to suspend disbelief to buy into fake science. But among the enthusiasm for unproven therapies rests a profound scepticism to orthodox, evidence-based healthcare.

Committed anti-vaxxers sometimes display a sort of religious zealotry that makes attempts at dialogue deeply frustrating. But there is no reason to dismiss the concerns of parents and caregivers who worry about autism, the effects of vaccines and the interventions of the medical profession. Putting pressure on people, shaming them or forcing them to do something that they are scared of is never a good idea. Most people are reasonable: give them the data and they are only too pleased that their child has access to life-saving vaccinations.

Ann Robinson is a GP.

CIDRAP News Scan for Feb 04, 2020 | The Center for Infectious Disease Research and Policy at the University of Minnesota.

WHO: Global flu levels still high, influenza A predominating.

In its latest global flu update yesterday, the World Health Organization (WHO) said flu levels are still elevated across much of the globe, with 79.2% of recent lab specimens testing positive for influenza A.

Though influenza B activity has defined the season in some countries in North America, only 29.8% of recent samples worldwide were classified as influenza B. Of the characterized B viruses, 1.4% belonged to the Yamagata lineage and 98.6% to the Victoria lineage, the WHO said. Of the subtyped influenza A viruses, 58.8% were influenza 2009 H1N1 and 41.2% were influenza H3N2.

Flu activity remains high in North America, with H1N1 and B viruses circulating, the WHO said. H1N1 is increasing in Mexico.

Though influenza activity remains high across Europe, several northern European countries reported a decrease of detections, including Ireland, England, and Wales. A decrease in flu activity was also seen across North Africa.

Russia has reported a predominance of influenza B, as have several countries in central Asia.

Flu activity remains elevated in most East Asia countries. Influenza-like activity seems to have decreased in China but remains high, with H3N2 and influenza B co-circulating.
Feb 3 WHO update

Montana game farm quarantined after CWD detection in elk meat.

For the first time since 1999, chronic wasting disease (CWD) has been detected in elk meat from a Montana game farm.

According to the Montana Department of Livestock (MDL), the detection was made via routine testing by the US Department of Agriculture CWD Herd Certification Program, which requires all deaths in captive animals greater than 12 months of age be tested for the deadly prion disease.

The animal had appeared healthy, and the detection has prompted a quarantine as the MDL investigates.

"An epidemiologic investigation will be conducted, but at this time, the source of the disease is unknown,” said State Veterinarian Marty Zaluski, DVM, in an MDL press release. "We will look at historical elk movements associated with this captive herd and proximity to infected wildlife to try to determine the source of exposure."

CWD is a progressive neurologic prion disease that affects cervids, including deer, elk, and moose.
Jan 31 MDL press release

Pronghorn, mountain goats, bighorn sheep might be susceptible to CWD.

Wild animals not in the deer family (or cervids) that might be susceptible to chronic wasting disease (CWD) include pronghorn, mountain goats, and bighorn sheep but probably not bison, according to a phylogenic analysis published yesterday in the journal Prion.

Scientists with the University of Alberta reviewed the literature on mammals naturally or experimentally exposed to CWD to identify susceptible and resistant species. They then created a phylogeny of these animals using cytochrome B, a protein found in mitochondria that can help assess the relatedness of species—and found that CWD susceptibility followed the phylogenic tree they created.

Using this phylogeny, the group estimated the probability of CWD susceptibility for wild ungulate species. They then compared the various forms of cellular prion protein, or PrP^C, among these species to identify which sites segregated between CWD-susceptible and CWD-resistant species. (PrP^C is the prion that, when misfolded, causes CWD). The researchers also identified sites that were significantly associated with susceptibility, but these sites were not completely discriminating.

Finally, they sequenced prion proteins from 578 wild ungulates (hoofed animal) to further evaluate their potential susceptibility and also looked at the animals' ranges in western Canada (CWD has been found in Alberta, Saskatchewan, and Quebec). Their analysis of the combined data suggests that CWD could affect pronghorn, mountain goats, and bighorn sheep, but bison are likely to be more resistant. They say pronghorn are most likely to be susceptible, at least in Canada.

The authors conclude, "Our current analysis highlights pronghorn antelope should be prioritized for inclusion in CWD surveillance activities given the proximity of the enzootic region in Canada to the pronghorn distribution."
Feb 3 Prion study

Two centuries of immunisation in the UK (part 1) | Archives of Disease in Childhood.

[Pay to View Full Text] [Received March 27, 2019; Revised June 17, 2019; Accepted June 18, 2019; First published July 4, 2019; Online issue publication January 22, 2020] [First notification on Post-Polio News: 8th July 2019]

Abstract.

The impact of immunisation is best understood through a historical lens, since so many of the diseases which placed a burden on our population have been eliminated or controlled through immunisation. The United Kingdom (UK) National Health Service (NHS), which celebrated its 70^th birthday in 2018, is responsible for delivering the highly successful universal national immunisation programme. However, the first vaccines used in the UK were not part of a centrally coordinated programme until the 1960s. Resources that summarise the first 200 years of immunisation in the UK are not readily accessible. Here we provide a two part chronological insight into the history of the UK immunisation programme from primary sources. In Part I, we highlight the importance of wartime conditions, unprecedented vaccine development, and the polio outbreaks in the in driving developments in immunisation and discuss subsequent changes in the use of the original vaccines of the immunisation programme, namely, diphtheria, tetanus, pertussis, and polio. In Part 2, we discuss the formation of the Joint Committee on Vaccination and Immunisation and its role, working with public health agencies and advising the UK Governments on vaccine policy, to bring a comprehensive programme to defend the health of the population against serious infectious diseases, highlighting the importance of programme organisation and leadership.

Pakistan: Army chief discusses Pakistan's fight against polio with Rotary International team |

[Tuesday Feb 04 2020]

RAWALPINDI: Chief of the Army Staff General Qamar Bajwa praised the efforts of Rotary International in Pakistan’s fight against polio, according to the Inter-Services Public Relations on Tuesday.

According to the army’s media cell, the army chief met with Rotary International’s four-member team.

In today’s meeting, measures related to healthcare in Pakistan and the country’s battle against poliovirus were discussed.

The army chief praised the contributions of the RI in the eradication of polio in Pakistan.

He also expressed hope that the efforts will lead to completely rooting out the disease from the country.

In January, it was reported that the overall tally of reported polio cases across the country reached 134 in 2019, including 91 cases in KP, 24 cases in Sindh, eight in Punjab and 11 in Balochistan.

The country is one of only three in the world where polio is endemic, along with neighboring Afghanistan and Nigeria, but vaccination campaigns have cut the disease sharply, compared with 306 in 2014 and more than 350,000 in 1988, according to Pakistani health officials.

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